Uterine clinical success

With the growing popularity of uterine fibroid embolization (UFE), the scientific evidence has also greatly improved. Evaluation of results associated with UFE has included clinical success rate and uterine/fibroid volume reduction. Cost, recovery time, change in quality-of-life and patient acceptance are other important considerations. The associated risks of complications associated with UFE are of paramount importance before offering this procedure to young women interested in future fertility. 

In conclusion, uterine artery embolization is both a safe and effective procedure to offer patients with symptomatic uterine fibroids. UFE has been described as a valuable alternative to hysterectomy and recurrent multiple myomectomy. Clinical success rates for control of heavy menstrual bleeding, pelvic pain and bulk-related symptoms have been reported to be 80%-95% of patients treated with a low rate of recurrence. The risk of major complications, including pulmonary embolism, uterine... 

Early recurrence of symptoms can occur when uterine artery embolization is performed on patients with adenomyosis (please see Chap. 10.4). Uterine artery embolization for adenomyosis is reported to be effective to control the bleeding initially [22,23] however, this clinical success is short-term. There is a high rate of clinical recurrence after embolization of the uterine artery for adenomyosis. In a recent study by Pelage et al, 44% of the patients required an additional treatment, including hysterectomies in 28% of the cases [24]. 

Nearly all the clinical data comes from the use of atosiban (see Peptide Antagonists), a peptide oxytocin antagonist that is licensed in Europe for acute (48 h) treatment of preterm labour. Early clinical studies demonstrated the ability of atosiban to inhibit uterine contractions associated with labour [14]. Following these successful phase II trials, full phase III trials were... 

Carboprost has been used successfully to control postpartum bleeding that was secondary to loss of uterine tone and where the myometrium was unresponsive to oxytocin, ergonovine, or methylergonovine. Given intramuscularly, carboprost causes an almost immediate and sustained uterine contraction. Clinical experience has shown that the use of this agent has saved many women from operative interventions (including hysterectomy) to control postpartum hemorrhage. 

Fig. 10.4.4. A 48-year-old woman with fibroid-related menorrhagia. Selective catheterization of a thin right uterine artery was performed but vessel perforation occurred (arrow) without clinical consequence. However, superselective catheterization and embolization was successfully performed using a microcatheter...

Leiomyosarcoma should be considered in cases where uterine size increases and symptoms persist after a technically successful UFE. Close clinical and imaging follow-up is necessary to detect and treat potential malignancy after UFE. 

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